Gulf War Syndrome

A cheat sheet for the news.
Oct. 26 1996 3:30 AM

Gulf War Syndrome

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Since shortly after the end of the 1990-'91 Persian Gulf War, veterans have complained of medical symptoms they say were caused by exposure to toxic chemicals during that conflict. And they charge that the government has not taken their complaints seriously, or is even covering up evidence of a Gulf War Syndrome. This past week, the Pentagon admitted that as many as 20,000 U.S. troops were exposed to nerve gas during the Gulf War, and the New York Times reported that Czech soldiers in the Gulf detected toxins "wafting over unprotected American troops." Where does the Gulf War Syndrome controversy stand?

The revelation that some troops were, in fact, exposed to toxic gases does not settle the case. The controversy rests on two remaining issues: finding a plausible description of the illness and finding evidence that the low-level toxic exposures could cause it.

After Iraq invaded Kuwait in August 1990, the U.S. led deployment of the coalition forces in the Persian Gulf, including 697,000 Americans, 45,000 British, and 4,500 Canadians. During this time, not only were Allied casualties far lower than feared, but overall rates of illness were low as well. Despite fears that Iraq would use chemical or biological weapons, no such attack came and no soldier became ill or died in the Gulf because of toxic-weapon exposure. (After entering an Iraqi bunker, one soldier experienced unexplained blistering, which could have been caused by mustard gas.)

After returning home, however, American, Canadian, and British veterans began reporting a variety of chronic symptoms that came to be called the Persian Gulf War syndrome. Common complaints are fatigue, joint pain, headache, difficulty sleeping, diarrhea, or nausea. The Department of Veterans Affairs registered and examined 18,600 American Gulf veterans who were concerned that they might have the syndrome. More than 67,000 filed disability claims for environmental sickness, unexplained illness, and other ailments.

No one has clearly defined what the syndrome really is. No characteristic symptoms or laboratory abnormalities have been found. Veterans quoted in New York Times articles, for example, each cited different complaints--from loss of teeth to tumors to memory loss to joint pain--and yet all were said to have the syndrome. The most frequent chief complaint (joint pain) was cited by only 11 percent of veterans in the VA registry. A majority of those registered did not share any of the top dozen symptoms. Other studies of Gulf War vets show no higher rates of hospitalization, birth defects, or death than among control groups that did not serve. Thus far, five different independent panels have evaluated the known evidence. None could find any new disease or define a unique syndrome.

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G ulf veterans and their supporters point to evidence that troops encountered many different chemical agents which, they believe, made thousands ill after coming home. Troops received multiple immunizations, including uncommon vaccines against anthrax and botulinum toxin. They took pyridostigmine pills as an antidote against nerve gas. The military used over a dozen pesticides in the Gulf, including organophosphates, which can cause nerve damage above certain levels. Oil fires in Kuwait billowed smoke over troops throughout the area. A Scud missile exploded over the 24th Naval Battalion, exposing its soldiers to rocket propellant and, some claim, mustard gas--a weapon used to rapidly induce blindness and severe skin burns.

Last spring the Pentagon reversed its long-standing denial that troops had been exposed to toxins while destroying Iraqi chemical weapons. Officials now admit that, in March 1991, troops were exposed to low levels of the nerve gas sarin when an Army battalion destroyed an Iraqi ammunitions depot. Initial estimates of 400 soldiers exposed were increased to 20,000, based on a CIA computer model of the gas cloud's drift. The number could be increased yet more as further data are generated. Czech soldiers confirmed detection of sarin even earlier, in January 1991, when Americans bombed Iraqi chemical plants. Sarin quickly triggers paralysis; death by asphyxiation or cardiac rhythm disturbances soon follows. It was used, for example, in last year's Tokyo subway attacks. But exposure levels in the Gulf were not high enough to cause such reactions.

Congress has already authorized disability payments of up to $21,876 per year for veterans with chronic maladies that appeared within two years after the war. The newest revelations about soldiers' exposure will add to pressure for more generous compensation.

Inconsistencies remain unresolved, however. First, expert panelists--including a Nobel laureate, a medical school dean, and epidemiology and environmental health experts--did not find it plausible that the chemicals could have failed to produce major ill effects at the time of exposure, yet could still cause chronic illness later. No known toxic illness has ever followed such a pattern. In medical circles, the argument over Gulf War Syndrome is actually part of a larger debate over the existence of other nebulous syndromes--including chronic fatigue and various environmental illnesses.

A second problem is that a Gulf War Syndrome with consistent symptoms has yet to be defined. Gulf veterans suggest that the syndrome is a constellation of symptoms; which ones a particular vet gets will vary with the individual. The syndrome may even be several illnesses, they say, but the common thread is exposure to toxins in the Gulf.

The independent panels, however, say none of the proposed chemical agents are known to cause disease at the low levels which troops faced. Moreover, they have not found any increase in illness among Gulf veterans as a whole or among those exposed to the proposed agents. For example, the engineers of the battalion exposed to sarin showed no higher illness rates than others. Some vets believe, however, that there is countervailing evidence which the government is covering up.

Atul Gawande, M.D., is a surgical resident at the Brigham and Women's Hospital in Boston.